Paediatrics Flashcards
What are the differentials for chronic stridor in an infant?
Laryngomalacia - MOST COMMON Laryngeal cyst, haemangioma or web Laryngeal stenosis Vocal cord paralysis Vascular ring GORD Hypocalcaemia Resp papillomatosis Sub glottic stenosis
What are the differentials for acute stridor in a child?
Croup
Inhaled foreign body
Anaphylaxis
Epiglottitis
A child age 6months - 6years, barking cough with stridor, and low grade fever.
What is the condition?
What causes it?
How do you treat it?
Croup - laryngotraceobronchitis
Usually caused by parainfluenza virus
Treated with oral dexamethasone. If very unwell may need nebulised adrenaline.
What causes epiglotitis?
Haemophilus influenza type B
Treated with cephalosporin
If suspected - stridor, septic, no cough DO NOT do anything to the child, no bloods or examination without an anaesthetist present.
Tonsilitis + false membrane over the fauces with a polyneuritis affecting the cranial nerves.
What is the condition?
Diphtheria
Describe the features of bronchiolitis?
Who it affects
Course of the illness
Organism responsible
Infants
What are the signs of respiratory distress?
Use of accessory muscles Tracheal tug High resp rate Flared nostrils Subcostal recession Grunting
When is it ok to send a child presenting with a respiratory illness home?
If SATS ok/ no resp distress Feeding ok (if
What causes a paroxysmal cough with an inspiratory whoop that last a very long time and how do you treat it?
Pertussis - whopping cough
Treat with erythromycin (only shortens the duration)
What conditions are tested for the on the new born blood spot test?
Cystic fibrosis
Phenylketonuria
Congenital hypothyroidism
Sickle cell
What are the clinical manifestations of cystic fibrosis?
Neonatal:
Meconium ileus
Intestinal atresia
Prolonged jaundice
Infant: Rectal prolapse Failure to thrive Malabsoprtion and vitamin deficiency Clubbing
Older children: Recurrent chest infections Difficult asthma Haemoptysis Nasal polyps Liver disease Diabetes
What is the population risk of being a CF carrier?
1 in 25 so the risk of producing a gamet with a CF gene is 1 in 50.
What is a viral induced wheeze?
A wheeze that starts after episode of LRTI
Usually in under 5yrs
No nocturnal cough, no wheeze on exercise, no hx of atopy.
Only 10% convert to asthma.
What is the one sign that suggests pneumonia?
A high temperature.
What are the congenital cyanotic heart conditions?
Conditions that cause R -> L shunting Tetraology of Fallots = cyanotic spells Transposition of the great vessels - cyanotic in first hours of life. Need to keep PDA open. Tricuspid or pulmonary atresia Hypoplastic left heart
What congenital cardiac conditions result in collapse once the PDA has closed?
Severe aortic coarctation
Aortic arch interruption
Hypoplastic left heart
Critical aortic stenosis
What are the features of an innocent murmur?
Short, soft, systolic, sounds normal (S1+S2), symptom less
Pansystolic murmur heard best at the L sternal edge.
What causes it?
What condition is it associated with?
Ventricular septic defect
Volume inversely proportional to the size of the defect
If large can present with heart failure at 4-8 weeks.
Associated with Down’s syndrome
What conditions are children with Downs syndrome more likely to have?
AVSD/ VSD Deudenal atresia Squint Hypothyroidism Leukaemia Hischprungs
Continuous machinery murmur.
What causes it?
How do you treat it?
Patent ductus arteriosus
Causes L -> R shunt
More common in preterms
Give indometacin
What would make you think a child had an atrial septal defect?
Wide splitting of S2.
Ejection systolic murmur over pulmonary area
Reccurent chest infections
Arrhythmias when >40yrs
What is Eisenmenger’s syndrome?
Shunt reversal, from L-> R shunt to R ->L shunt due to pulmonary hypertension when the R sided pressures get so high.
Patients become cyanotic
What conditions are associated with coarctation of the aorta?
Tuner’s syndrome
Marfans
Can produce a systolic murmur heard between the scapular
NEED TO KEEP DUCT OPEN
What is Tetraology of Fallot?
Pulmonary stenosis R ventricular hypertrophy Over riding aorta VSD (often cant heat ES mumur as the defects are too large)
What congenital heart conditions are these conditions associated with?
Maternal rubella, SLE and DM
Maternal use of warfarin and EtOH
Williams, Noonan, and 22q11 deletion.
Maternal rubella - Multiple VSDs, periperhal pulmonary stenosis.
SLE - complete heart bock
DM - all heart conditions
Maternal warfarin - pulmonary valve stenosis, PDA
Fetal alcohol syndrome - ASD, VSD, tetralogy
Williams - supravalvular AS, peripheral pulmonary stenosis
Noonan - hypertrophic cardiomyopathy, ASD, pulmonary valve stenosis
22q11 deletion - coarch, TOF
What are the differentials for Tall Stature?
Familial Tall Stature - most common
Marfans or Klinefelter (47 XXY)
Growth acceleration due to precoious puberty, thyrotoxicosis or increased growth hormone)
What clinical signs suggest that there is a pathological cause for short stature?
Extreme short statue - on or below 0.4th centile
Short for family size
Short and relatively over weight (? endocrine)
Short and under weight (? poor nutrition)
Growth failure - crossing centile lines
Dysmorphic features
Skeletal dysproportion
Signs of systemic disease
What are the cause of short statue?
Constitutional Psychological neglect Poverty, physical abuse Drugs (steroids) Genetic - turners, CF Ineffective diet - coeliac IBD Hypothyroidism Infection low Growth hormone
What the the pathology behind congenital adrenal hyperplasia?
Increased secretion of androgenic hormones due to a deficinecy of 21 hydroxylase.
Cortisol and other steriods are not formed so there is a build up of androgens.
Need life long steriod replacement, both mineral and cortisol.
What the the pathology behind congenital adrenal hyperplasia?
Increased secretion of androgenic hormones due to a deficinecy of 21 hydroxylase.
Cortisol and other steriods are not formed so there is a build up of androgens.
Need life long steriod replacement, both mineral and cortisol.
What condition causes non bilious vomiting?
Infantile hypertrophic pyloric stenosis
More common in boys with a family history. The vomiting is often projectile.
What metabolic disturbance is seen with infantile hypertrophic pyloric stenosis and why?
Hypochorlemic alkalosis due to vomiting HCL
Hypokalaemia due to the kidneys retaining hydrogen ions in favour of the potassium ions.
What condition causes paroxysms of crying, blood in the stool and vomiting?
Intussusception - where one section of the bowel invaginates into another.
Normally in 6months - 2 year olds.
Treated with an air enema or surgery
What are the causes of chronic diarrhoea (>14days)
Infection:
Salmonella/ campylobacter
Giaredia
Post gastroenteritis diarrhoea
Malabsorption: Lactose intolerance Cows milk protiein intolerance CF Coeliacs
IBD
Miscellaneous: Toddler's diarrhoea IBS Drugs - laxitives, abx, chemo Immunodeficiency
What is the most common cause of viral gastroenteritis in children?
Rotovirus
How do you calculate maintenance fluid for children?
100ml/kg for first 10kg
50ml/kg for the next 10kg
20ml/kg for the everything after….
When would you worry about hirsprungs in a constipated child?
Symptoms since birth Bowels not open in first 48hrs of life Bilious vomiting Neuro symptoms Faltering growth
Which antibodies are specfic for coeliacs?
IgA anti tissue transglutaminase, anti-gliadin and endomysial antibodies.
IgA needs to be measured as if there is an IgA deficiency then need to measure IgG anti gliadin antibodies.
When does jaundice in the newborn need investigating?
If it is present before 24hrs of birth: Sepsis Rhesus incompatibility ABO incompatibility Red cell anomalies - G6PD, spherocytosis
Prolonged >14days: Breastfeeding Sepsis Hypothyroidism CF Biliary atresia (conjugated)
What is the most common causes of inguinal hernia in babies?
Patent processus vaginalis
What is the difference between a DMSA and a MAG3 scan?
DMSA is a static scan of the renal cortex, good at looking at scars
MAG3 scan is a dynamic measuring of the drainage of the kidneys. If can pass urine on demand can add an indirect cystograme to look for VUR.
What are the signs of nephritis and what are the causes?
frank haematuria, oliguria and HTN
B haemolytic strep HSP Toxins or heavy metals Berger's disease Malignancy Viruses Renal vein thrombosis
What is the triad of nephrotic syndrome?
Proteinuria
Hypoalbumineamia
Oedema
Can use steroids to try and manage it. Should have prophylatic penicillin to cover immunosupression
What are the differentials for high blood pressure in children?
Cardiological - coarch
Renal - nephritis, renal artery stenosis
Essential
Endocrine - cushings, thyrotoxicosis, phaechromocytoma
Drugs - steriods, COP.
HTN in prepubesent children is worrying
What bacteria is usually the cause of haemolytic uraemic syndrome?
E.coli, post diarrhoea.
What bacteria is usually the cause of haemolytic uraemic syndrome?
E.coli, post diarrhoea.
A child has a cough, conjuctivitis, fever for 3-5 days and then a rash appears behind their ears and spreads all over the body.
What is the illness?
What are the complications?
Measles (RNA paramyxovirus)
Pneumonia
Corneal ulceration (can lead to blindness)
Suppurative otitis media (can result in deafness)
Gastroenteritis
Febrile convulsions
Encephalitis
Subacute sclerosing paraencephalitis - develops 7-13yrs after the infection and leads to progressive changes in behaviour, myoclonus, dementia and death.
A child has a cough, conjuctivitis, fever for 3-5 days and then a rash appears behind their ears and spreads all over the body.
What is the illness?
What are the complications?
Measles (RNA paramyxovirus)
Pneumonia
Corneal ulceration (can lead to blindness)
Suppurative otitis media (can result in deafness)
Gastroenteritis
Febrile convulsions
Encephalitis
Subacute sclerosing paraencephalitis - develops 7-13yrs after the infection and leads to progressive changes in behaviour, myoclonus, dementia and death.
What are the diagnostic criteria for Kawasaki’s disease?
And how do you treat it?
Fever for > 5days +
Non purulent conjunctivitis
Cervical lymphadenopathy
Rash
Erythema of the oral and pharyngeal mucosa
Erythema and swelling of the hands and feet, followed by desquamation.
Treat with high dose aspirin and IVIG
Complications = coronary artery aneurysms
What are the causes of a prolonged fever?
Infections - HIV and TB Malignant disease Autoimmune disorders - juvenile idiopathic arthritis Drugs IBD
A child presents with a macular rash, lymphadenopathy sub occipiatally, and painful hands.
What is the illness
How long are they infective for?
Rubella
5 days before and 5 days after the rash starts
What are the complications of mumps?
Usually none
Can cause orchitis (+/- infertility), arthritis, meningitis, pancreatitis, myocarditis, deafness, myelitis
What are the complications of mumps?
Usually none
Can cause orchitis (+/- infertility), arthritis, meningitis, pancreatitis, myocarditis, deafness, myelitis
What causes slap cheek disease?
Parvovirus
Can lead to aplastic crisis if the patient already has RBC with a short life span.
What does maternal parvovirus do to the fetus?
Can lead to hydrops
Also can cause: growth retardation, meconium peritonitis, myocarditis, glomerulonephritis, placentomegaly, hepatomegaly, oedema, pancytopenia
10% affected before 20 weeks will misscarry, in the rest congenital abnormality is 1%
What causes hand foot and mouth disease?
Coxsackie virus or enterovirus
What causes roseola infantum?
Herpes Virus 6
Characterised by a fever that on subsidence leaves a maculopapular rash.
AKA fourth disease
When does specialised help need to be sought in chicken pox?
When the spots are blackish (purpura fulminans) or coalescing and bluish ( necrotizing fascitis)
What does maternal varicella do to the fetus?
Cerebral cortical atrophy and cerebellar hypoplasia, microcephaly, convulsions and low IQ
Limb hypoplasia, rudimentary digits
Pigmented scars
What are the symptoms of scarlet fever?
What causes it?
How do you treat it?
Rash, fever strawberry tongue and desqumation.
Endotoxin mediated from strep pyogenes
Give penicillin
What are the symptoms of scarlet fever?
What causes it?
How do you treat it?
Rash, fever strawberry tongue and desqumation.
Endotoxin mediated from strep pyogenes
Give penicillin
What are the causes of pancytopenia?
Bone marrow failure or bone marrow infiltration.
Bone marrow failure = inherited (v rare) or acquired (hepatitis, herpes, EBV, drugs, idiopathic aplastic anaemia)
Infiltration is normally painful and associated with other symptoms and signs (leukaemia or neurblastoma)
What are causes of purpura in children?
Infections ITP Leukaemia HSP vomiting/ coughing Trauma Clotting disorders Drugs ie steroids
How do patients with acute lymphoblastic leukaemia present?
Pancytopenia (infections, anaemia, bleeding) Fatigue Anorexia Fever Bone pain Painless lumps in neck or groin
What syndrome is a Wilms tumour assoicated with?
Beckwith wiedemann syndrome
What is seen on the EEG of a patient with absence seizures?
3 hz spikes
What symptoms do temporal lobe seizures cause?
Lip smacking, stop and stare into the air
What symptoms do benign rolandic seizures cause?
On waking or when asleep. Facial twitching, with oropharngeal symptoms like salivation.
Get centro temporal spikes on the EEG
When a baby has spasms (curling forward and stretching arms out), developmental delay and hypsarrythmia on the EEG what is this suggestive of?
West syndrome.
Prognosis is poor
What are the differentials for a child with a large head?
Hydrocephalus Vascular malformations Tumour Subdural haematoma Fragile X syndrome Neurofibromatosis Overgrowth syndrome Metabolic Familial macrocephaly
What are the causes of cerebral palsy?
Fetal - structural abnormalities
Perinatal - premature, hypoxia at birth
Inborn errors - of metabolism or genetic defects
Infancy - traumatic brain injury, meningitis
Unknown
What are the reasons for childhood circumcision, and which are available on the NHS?
Hypospadias, phimosis that is obstructing flow of urine, religious custom and tribal custom, and hygiene.
Circumcision on a healthy boy is not indicated on the NHS.
How can parents adapt the diet of their child to improve their child’s toddlers diarrhoea ?
Increase the fat in their diet - it should contain 30-40% fat
Reduce squash and fruit juice, try and drink water
Eat lots of fibre
What vaccines need to be given when?
2 months (2 injections + 1 drops)
Diphtheria, tetanus, pertussis, polio and Hib
Pneumococcal
Rotavirus
3 months ( 2 injections + 1 drops)
Diphtheria, tetanus, pertussis, polio and Hib
MenC
Rotavirus
4 months (2 injections)
Diphtheria, tetanus, pertussis, polio and Hib
Pneumococcal
12-13 months (3 injections)
Hib/ MenC
Pneumococcal
MMR
Pre school (2 injections)
Diphtheria, tetanus, pertussis, polio and Hib
MMR
Girls 12-14
HPV
14 yrs
Tetnus, diphtheria and polio
MenC
